KAP study on Breastfeeding and Weaning in a Low Socio-economic Area in Sudan, 2020-2021

doi:10.21203/rs.3.rs-4331724/v1

Background: Breastfeeding is the gold standard of infant and young child feeding and an essential factor for their health and overall well-being. This study aims to assess the influence of socio-economic determinants on knowledge, attitude and practice of breastfeeding and weaning among mothers of children aged two years and below in the suburbs of Khartoum locality.

Materials and Methods: A community-based cross-sectional study was conducted on 196 mothers of children selected through systematic random sampling.

Results: Around 53% of participants had good knowledge on breastfeeding and weaning, and 60% of respondent had positive attitude towards breastfeeding and weaning. With regards to practice; breastfeeding initiation during the first hour was practiced by 94%, approximately 8% of participants had given pre-lacteal feed, colostrum feeding was done by 86.7%, around22% of women fed their child from one side until the whole breast is emptied out, 41% of mothers practicing breastfeeding on demand, 45% mothers had practiced or were currently practicing exclusive breastfeeding, almost 29% started introducing complementary food after the age of 6 month, and the most common types of complementary food introduced were boiled vegetables (94%). Socio-economic status significantly associated with poor knowledge were age below 25 years (p=0.007), primary education and below (p= 0.000) and mothers working in marginal business (p=0.008). While negative attitude was significantly associated with primary school education and below (p =0.04) and income of < or =10 000 Sudanese pounds per months (p =0.05). Mothers on marginal business jobs were more likely to have poor knowledge when compared to employed women (OR= 7.3, p 0.034). Those of primary education and below were likely to have poor knowledge than those with education level of secondary school and above (OR=4.8, p= 0.000). Whereas, those younger than 25years were more likely to have poor knowledge than older mothers (OR=2, p 0.026). Mothers who delivered at home had lower knowledge levels as to those who gave birth in a health institute (OR=2, p=0.019).

Conclusion and recommendation: There is a need for mass education campaigns to promote optimal breastfeeding and weaning practices coupled with counseling during antenatal and postnatal periods

Breastfeeding

weaning

low socio-economic area

knowledge

attitude

practice

Sudan

Breast milk is a precious gift for children and mothers alike. containing a wide variety of essential nutrients and immunological factors. [1,2] Breastfeeding is defined by the World Health Organization (WHO) as "an unequalled way of providing ideal food for the healthy growth and development of infants" Additionally, breast milk is hailed as an effective instrument in advancing the Global Women's, Children's, and Adolescent's Health (2016–2030) agenda, which was initiated alongside the Sustainable Development Goals (SDGs). These goals serve as a roadmap towards eliminating preventable mortality within a generation. [3] Within the Sustainable Development Goals (SDGs), Goal 3 prioritizes the reduction of the global maternal mortality ratio and the eradication of preventable deaths among newborns and children under 5 years of age, placing these objectives at the forefront of the agenda. [4] Furthermore, breastfeeding is endorsed by both the American Academy of Pediatrics (AAP) and the United Nations Children's Fund (UNICEF) as the optimal infant feeding practice [5,6] Beyond the nutritional advantages, breastfeeding provides a broad array of benefits to both mother and child, spanning from physiological to psychological realms, with effects that are both immediate and long-lasting [7, 8,9,10,11,12]

As per the 2020 report from the United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), over 5 million children passed away before reaching the age of 5, primarily because they lacked access to basic, inexpensive interventions such as exclusive breastfeeding and proper feeding practices.[13]

The perceptions and behaviors surrounding breastfeeding and weaning are shaped by various socio-economic factors, such as the mother's literacy level, socio-cultural norms, maternal age, family income, and social status, among others. To the best of the researcher's knowledge, there have been limited studies conducted in Sudan that comprehensively examine the impact of socio-economic factors on breastfeeding and weaning practices. Therefore, it is crucial to investigate and pinpoint gaps in knowledge, attitudes, and practices within this economically disadvantaged group. The findings of this research can provide an invaluable basis for policymakers and decision-makers develop evidence-based interventions aimed at enhancing breastfeeding practices among vulnerable segments of society.

2.1 Study design: Community-based analytical cross-sectional study design.

2.2 Study area: The study was conducted in Soba station neighborhood, located in southern outskirts of Khartoum state.

2.3 Study duration: 2020–2021

2.4 Study population: According to Soba administrative Units’ statistics an estimated total population of soba station inhabitants is approximately 6840 persons. Because of the absence of precise statistics regarding the exact number of children in the region, the researcher relied on estimated figures provided by the State Ministry of Health

2.5. Sample size and sampling technique:

2.5.1 Sample size:

Sample size was calculated using Krejcie and Morgan formula (1970)

After applying the above formula, the resultant sample size: N = 196

2.5.2 Sampling techniques: The systematic sampling techniques. The interval of sampling was calculated by dividing the total number of houses by sample size.

Interval = 1000/196 = 5

The first house was selected randomly using simple random sampling.

2.6. Inclusion criteria:

All mothers of children aged 2 years and below are included in the study.

2.7. Exclusion criteria:

Mothers whose children have died.
Mothers of children with cleft lip with/without cleft palate.
Mothers who refused to participate in the study.

2.8 Data collection tools and methods.

The data was collected using a well-structured mixed questionnaire comprising four primary sections: Socio-demographics, knowledge, attitude, and feeding and weaning practices. Data collection involved direct face-to-face interviews with mothers conducted by two trained data collectors. These collectors ensured adherence to all protective measures against the COVID-19 pandemic.

During household visits, if no child under the age of two years was present, the next eligible household meeting the inclusion criteria was selected. The questionnaire underwent a pilot phase, during which necessary adjustments and corrections were made based on feedback received.

2.9 Data management and analysis:

Data was entered, cleaned and analyzed in Statistical Package for Social Sciences (SPSS) version 26. Data was presented in tables and figures. Multinomial regression test was used to test for predicators of knowledge, attitude and practice at a significant level of 0.05.

2.10 Ethical consideration:

Ethical and scientific approval was obtained from the Research Committee at the Department of Community Medicine, Faculty of Medicine, University of Khartoum. Subsequently, informed written consent was obtained from all participants before conducting the interviews. The confidentiality of the data has been strictly maintained, and it has only been utilized for the purpose of this research.

A total of 196 mothers with children aged ≤ 2 years residing in the low socio-economic area of Soba Almahta (Soba station), located in the southern outskirts of the capital city, Khartoum, were interviewed for this study.

In terms of socio-economic data, the average age of mothers was 28.7806 years with a standard deviation of 5.80608. The majority of mothers fell within the age range of 26–30 years. Regarding education levels, 7.7% of mothers were illiterate, while 48.5% had completed primary school education. The vast majority (83.2%) of respondents were housewives, and 70% reported a monthly income of less than 10,000 Sudanese pounds. Regarding the site of delivery of children, deliveries were almost evenly distributed between home and institutional settings, each accounting for around 50% of cases. However, vaginal delivery was by far the most common mode of delivery, accounting for 87% (170) of births.

Table (1): Knowledge about breast-feeding and weaning:

variable	No	%
Best food for the child
Breast feeding	184	93.9
Industrial feeding	12	6.1
Advantages of Breastfeeding for the Child
Increases immunity and prevent diseases	68	34.7
Increases intelligence	10	5.1
Help in early teeth eruption	7	3.6
Strengthens mother-child relationship	18	9.2
I don’t know	122	62.2
Advantages of breastfeeding for Mother
Cheap	1	0.5
Strengthens mother-child relationship	17	8.7
Natural contraceptive method	9	4.6
Protects mother from cancer	24	12.2
I don’t know	152	77.6
Optimum time for initiation of breastfeeding
1/2 − 1 hour after delivery	183	93.4
more than one hour	12	6.1
I don't know	1	0.5
Exclusive breastfeeding duration
less than 4 months	20	10.2
up to 4 months	76	38.8
up to 6 months	82	41.8
more than 6 months	15	7.7
I don't know	3	1.5
Breastfeeding Age
less than 1 year	3	1.5
less than 2 years	29	14.8
Until 2 years	162	82.7
I don't know	2	1.0
Humans have colostrum
yes	163	83.2
no	2	1.0
I don't know	31	15.8
Colostrum Beneficent
yes	155	79.1
no	6	3.1
I don't know	35	17.9
Thoughts about night feeding
important	165	84.2
not important	5	2.6
tiring	20	10.2
I don't know	6	3.1
Definition of weaning
stop breast feeding	156	79.6
added other food type beside breast milk	37	18.9
I don't know	3	1.5
Suitable age of baby to start introducing supplementary feeding.
less than 4 months	20	10.2
4–6 months	83	42.3
after 6 months	91	46.4
I don't know	2	1.0

The majority of women, comprising 94% (184), recognized breastfeeding as the best nutrition for their child. However, there was uncertainty regarding the specific benefits of breastfeeding for both the child and mother. When asked about the optimal timing for initiating breastfeeding, the duration of breastfeeding, the definition of weaning, the benefits of colostrum feeding, and the importance of night feeds, the most common responses were accurate. However, there was ambiguity regarding the duration of exclusive breastfeeding, with almost equal proportions of respondents suggesting up to 4 months (39% or 76) and up to 6 months (42% or 82) respectively. Similarly, confusion was noted regarding the appropriate time to introduce supplementary feeding, where participants were mainly split between “4–6 months” and after 6 months at 42% (83) and 46% (91) respectively. Check table (1).

The attitude towards breastfeeding was generally positive. However, in some areas around a third of the participants had a negative attitude particularly; the notion that breastfeeding is an old fashion practice 35% (68) see table (2).

Regarding breastfeeding practices, the majority of participants reported adhering to best practices such as initiating breastfeeding promptly, abstaining from feeding the child anything before the first breastfeeding, providing colostrum feeds, practicing night feeding, and continuing breastfeeding after introducing complementary foods. However, 59% (116) breastfed on a schedule, half of the participants (51% or 99) breastfed for less than 6 months, and a little over half (51% or 100) introduced complementary feedings at 6 months of age. Table (3).

variable	No.	%
Breastfeeding prevents the child from infection
agree	160	81.6
I don't agree	28	14.3
I don't know	8	4.1
Breastfeeding is an old fashion
agree	68	34.7
I don't agree	124	63.3
I don't know	4	2.0
Breastfeeding is more beneficial for infants
agree	191	97.4
I don't agree	4	2.0
I don't know	1	.5
Breastfeeding is embarrassing
agree	19	9.7
I don't agree	177	90.3
Breastfeeding strengthening mother-child relationship
agree	187	95.4
I don't agree	8	4.1
I don't know	1	.5
Breastfeeding prevents you from going to work
agree	64	32.7
I don't agree	131	66.8
I don't know	1	.5
Breastfeeding should be stopped during mother illness
agree	68	34.7
I don't agree	127	64.8
I don't know	1	.5
Breastfeeding should be avoided during child illness
agree	11	5.6
I don't agree	185	94.4
I don't know	0	0

Table (2): Attitude towards breast-feeding and weaning:

In terms of knowledge, the majority of participants, accounting for 53%, demonstrated good knowledge and scored above the mean knowledge score in this study. Concerning attitude, the majority of respondents, comprising 60%, exhibited a positive attitude and scored above the mean attitude mark.

Table (3) Mother's practice towards breastfeeding and weaning:

Variable	No	Percentage
Start breastfeeding
immediately after delivery	184	93.9
during the first 24 hours	10	5.1
after 24 hours	2	1.0
Child receive any meal before the first breastfeeding
yes	16	8.2
no	180	91.8
Child receive any of the colostrum
yes	170	86.7
no	5	2.6
I don’t know	21	10.7
Breast feed time
Scheduled	116	59.1
On demand	80	40.8
Breastfeeding style used commonly
from one breast	43	21.9
from both breasts	153	78.1
Duration of exclusive breastfeeding
< 6 months	99	50.5
6 months	48	24.5
more than 6 months	10	5.1
Still on exclusive breastfeeding	39	19.9
Night feeds
yes	194	99.0
no	2	1.0
Start complimentary feeding
less than 4 months	20	10.2
4–6 months	80	40.8
after 6 months	57	29.1
Not yet	39	19.9
Continuation of breast feeding after introducing complimentary feeding
yes	154	78.6
no	3	1.5
Still on exclusive breastfeeding	39	19.9

Figure (1): Bar chart showing types of complimentary feeding practice.

Among mothers who introduced supplementary food to their child (n = 157), the majority initiated with boiled vegetables (94%), legumes (92%), and mashed cereals (92%). figure (1)

Table (4): Socio-economic risk factors influencing Knowledge and attitude towards breastfeeding and weaning

Knowledge	Factors	Reference	P	OR	Lower	Upper
	=< 25 years	> 25 years	0.026	2.169	1.095	4.295
	Primary school and below	Above primary school	0.000	4.795	2.495	9.212
	housewives	Employed women	0.043	5.063	1.051	24.397
	Independently employed	Employed women	0.034	7.907	1.169	53.743
Reference category good knowledge
Attitude	Home delivery	Institutional delivery	0.019	2.08	1.130	3.828
	Factors	Reference	P	OR	Lower	Upper
	Primary school and below	Above primary school	0.712	2.5	0.697	2.977
	=< 10 000	> 10 000	0.324	1.441	0.697	2.977
Reference category positive attitude

Regarding socio-economic factors predicting knowledge, all factors - age, education, and site of delivery - initially showed significant associations in the chi-square test. However, after running the variables in a single multinomial regression model, only employment status emerged as a statistically significant predictor. Mothers in independent jobs were found to be 7.9 times more likely to have poor knowledge compared to employed women, with a p-value of 0.034. Similarly, housewives exhibited 5 times less knowledge than employed women, with a p-value of 0.043 refer to Table (4).

Participants with primary education or below were 4.8 times more likely to have poor knowledge compared to those with higher education levels, with a p-value of 0.000. Additionally, women younger than 25 years were found to be 2 times more likely to have poor knowledge compared to older women, with a p-value of 0.026. Moreover, mothers who delivered at home had knowledge levels that were 2 times lower than those who gave birth in a health institute. Table (4)

Regarding attitude, the only significant factors in Chi-square test were education and income levels. However, when these variables were tested using a multinomial regression model, none of them emerged as significant predictors of attitude. Table (4)

Breastfeeding stands as the gold standard for infant and young child feeding, playing a pivotal role in shaping the long-term health of newborns and infants. The study specifically targeted the knowledge, attitudes, and practices regarding breastfeeding and weaning among mothers with children aged two years and below in a low socio-economic area where low income, education and marginal occupation domains were expected.

The average age of mothers in this study was 28.8 years with a standard deviation of 5.81, a figure quite similar to that observed in Egypt by Mohammed et al. in 2016, which reported an average age of 28.4 years with a similar standard deviation. Interestingly, in the current study, 93% of participants had at least primary education, a significantly higher proportion compared to Egypt where only 44.3% of mothers were literate. [15] Conversely, in Ethiopia, the percentage of mothers with primary education and above was much lower at 31.3%.[16] In terms of employment status, 83.2% of mothers in the current study were housewives, slightly lower than the figure reported in El-Minia, Egypt (93.2%). Conversely, in the United Arab Emirates, the percentage of unemployed mothers was lower than both the current study and that of El-Minia, Egypt, standing at 60.4%.[17]

In this study, the proportion of children delivered by caesarean section was five times higher compared to Ethiopia, with rates of 13.3% and 2.5% respectively. Furthermore, concerning the number of children, 62.8% of participants in the current study had more than two children, whereas in Ethiopia, this figure was higher at 79.2%. However, it's essential to note that this difference could be attributed to the methodology employed in data collection. This research gathered data on the number of alive children, while the study in Ethiopia focused on the number of parities, which includes both alive and deceased children. [16]

Ninety-four percent of interviewed mothers in this study acknowledged breastfeeding as the best nutrition for children under 2 years. However, this percentage was lower compared to findings in a rural area in El-Minia governorate, Egypt, where it was reported as 100%. Furthermore, in the current study, a significant proportion (62.2%) of participants failed to accurately identify the specific benefits of breastfeeding for the child. Only 34.7% mentioned that breastfeeding strengthens immunity and prevents diseases, contrasting sharply with the findings in El-Minia, Egypt, where 97.7% of participants recognized the impact of breastfeeding on immunity and disease prevention. [15]

Regarding the benefits of breastfeeding for the mother, a noteworthy percentage (77.6%) of study participants in this research were unaware of any advantages. Moreover, only a small fraction (9.2%) of participants recognized the benefit of breastfeeding in fostering mother-child bonding, which sharply contrasts with the findings in El-Minia, Egypt, where 95.8% of participants acknowledged this advantage. On the other hand, concerning the protective effect of breastfeeding on breast cancer, a higher percentage of participants in this study (12.2%) mentioned it compared to the research in Egypt (4.6%). [15]

Ninety-three percent of participants in this study were aware of the optimal time for initiating breastfeeding within the first hour of delivery, which is higher than the figures reported in the study by Mohammed et al. in Egypt (83.7%) [15], and the study by Chavan et al. in India (79.1%).[18] Regarding the duration of exclusive breastfeeding (EBF), 41.8% of participants knew that EBF should be continued until 6 months of age, which is higher compared to the findings in El-Mina, Egypt (32.2%).[15] Furthermore, the awareness of the duration of EBF in this study was even higher than that of respondents from France, Britain, and the United States (35.5%, 29.8%, and 23.4% respectively) in the study by Wei Chun Wang, 2017, [19] nonetheless lower when compared to the findings in Italy where 71% of participants responded correctly to the optimum duration of breastfeeding. [20].

In this study, 79% of participants recognized colostrum feeding as important, which is lower compared to a study in India where all participants (100%) were aware of its importance. [21] Furthermore, the figure is even lower in a systematic review in East Africa, which found that only 52.1% of participants agree that colostrum is important. [22]

These discrepancies could be attributed to cultural differences across the countries, which are geographically distant from each other. Cultural beliefs and practices regarding infant feeding may vary widely, influencing levels of awareness and understanding regarding colostrum feeding.

Regarding weaning, approximately 80% of mothers in this study had a misconception of weaning as complete cessation of breastfeeding, which is similar to the findings of a study by Kiran Bala et al., in India where 80.3% of participants also falsely defined weaning. [21] This misconception was even more prevalent among Egyptians, with as high as 92% defining weaning as complete cessation of breastfeeding in the study by El-Minia. [15]

In terms of attitude, 35% of participants in this study agreed that breastfeeding should be stopped during the mother's sickness, whereas in Egypt, this figure was as high as 83%.[15] Additionally, around 10% of participants in this study found breastfeeding embarrassing, while 80% of Egyptians found it embarrassing. [15] This difference could be attributed to the relative normalization of breastfeeding in the daily lives of Sudanese women. Furthermore, participants in this study showed a more positive attitude towards continuing breastfeeding for a sick child compared to their Egyptian counterparts [15], with 94% and 80% respectively.

Regarding breastfeeding practice, 94% of participants initiated breastfeeding during the first hour, which is high in relation to 81.8% in Ethiopia, [16] and approximately 60% in Abu Dhabi, United Arab Emirates. [17] Pre-lacteal feed was not common and only 8% of participants gave pre-lacteal feed to their children which is low compared to about two third 66% in the study of Kiran Bala et al.[21]

Colostrum feeding was done by 86.7% which is high compared to many other studies like that in Pakistan by Moazzam Ali Khan et al, 2016 in which colostrum feeding was 73% [23] and of El-Minia Egypt which was 74%.[15] Only 21.9% of women fed their child from one side until the whole breast is emptied out so that the baby gets hind milk which is important for the brain development. This was relatively high compared to 17.3% in the study of Mohammed et al. [15] Breastfeeding on demand was rather unpopular in our study with around 41% of mothers practicing it, unlike the research of Mohammed et al, Egypt in which almost 96% breastfed on demand. This could be due to that there were a higher percentage of employed mothers in this study, hence less availability to breastfeed on demand. Prolactin is secreted after feed to produce next feed. As secretion of prolactin is more at night, suckling at night is encouraged. In the current study 99% of mother’s night-fed their children which is high compared to 72%in. Mohammed et al. study. [15]

Furthermore, in this study, 45% of the respondents had practiced or were currently practicing exclusive breastfeeding, which is lower (81.7%) compared to a study conducted in Brazil by Morais et al. in 2016, [24]. This rate was very close to that found in Abu Dhabi, UAE, where 44% of children < 6 months were exclusively breastfed. [17] Conversely, in a study in Italy by Cascone et al, approximately 33% of mothers breastfed exclusively [19], while in Western Saudi Arabia, the rate was 28%.[25]

Moreover, in the current study, only 29% introduced complementary feed after the age of six-months. Unfortunately, this rate was even lower in the research conducted by Bala et al. in 2020 in India, where only 18% of mothers introduced complementary food after this age. [21]

The most common types of complementary food introduced were boiled vegetables (94%) which was similar to that of Panting Lu et al in China (98%) for cereals and potatoes.[26] Furthermore, cow milk was introduced to 40% of children as complimentary feeding. Whereas in Brazil, an increased cow milk consumption from (31.1%) during the first 6 months of age to (81.7%) during the second year of life. [24]

Regarding occupation, mothers on independent jobs(marginal business) were 7.9 times more likely to have poor knowledge when compared to employed women at p-value of 0.034, Housewives showed a 5 times less knowledge than women employed p-value 0.043.This could be due to that employment in the formal sector requires that employees to be of a certain minimum level of education.

Those of primary education and below were 4.8 times likely to have poor knowledge than those with education level higher than primary school, at p-value 0.000. This could be due to the exposure to breastfeeding and nutrition lessons during their education journey whereas; those younger than 25 years were 2 times more likely to have poor knowledge than older women with a p-value 0.026 this could be explained by the years of cumulative knowledge gained by elder women. Mothers who delivered at home had 2 times lower knowledge levels than those who gave birth in a health institute this could be explained by the possible exposure of those who delivered at institute to instruction and counseling by a trained health personnel on the importance of breastfeeding.

With respect to attitude, the only significant attributable factor was education and income level; and when these variables were tested using multinomial regression model none of them was a significant predicator of attitude.

According to the findings of the present study, it was concluded that the majority of mothers from the studied low socio-economic area had good knowledge and positive attitudes. However, some practices were suboptimal. Knowledge about breastfeeding was less especially among mothers who were younger less educated, working in marginal businesses or who delivered at home.

Ethical approval and consent to participate: Ethical and scientific approval was obtained from the Research Committee at the Department of Community Medicine, Faculty of Medicine, University of Khartoum. Subsequently, informed written consent was obtained from all participants before conducting the interviews. The confidentiality of the data has been strictly maintained, and it has only been utilized for the purpose of this research.

Consent for publication: Not applicable.

Availability of data and materials: Data is provided within supplementary information files

Competing interests: I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Funding source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions : R. A. and I. A. wrote main manuscript text

M. A. and M. G. prepared tables and figures

H. A. contributed to results and analysis

All authors reviewed the manuscript

Acknowledgement:

First and foremost, praises and thanks to God for his blessings throughout my research work to complete this research successfully.

I would like to express my sincere gratitude to my colleague Amani Idris who accompanied me through the journey of data collection.

Finally, last but by no means least; I want to thank my friends, family and my husband for encouragement and support.

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Table (1): Knowledge about breast-feeding and weaning:

variable	No	%
Best food for the child
Breast feeding	184	93.9
Industrial feeding	12	6.1
Advantages of Breastfeeding for the Child
Increases immunity and prevent diseases	68	34.7
Increases intelligence	10	5.1
Help in early teeth eruption	7	3.6
Strengthens mother-child relationship	18	9.2
I don’t know	122	62.2
Advantages of breastfeeding for Mother
Cheap	1	0.5
Strengthens mother-child relationship	17	8.7
Natural contraceptive method	9	4.6
Prevents post-partum hemorrhage	4	2
Protects mother from cancer	24	12.2
I don’t know	152	77.6
Optimum time for initiation of breastfeeding
1/2 -1 hour after delivery	183	93.4
more than one hour	12	6.1
I don't know	1	0.5
Exclusive breastfeeding duration
less than 4 months	20	10.2
up to 4 months	76	38.8
up to 6 months	82	41.8
more than 6 months	15	7.7
I don't know	3	1.5
Breastfeeding Age
less than 1 year	3	1.5
less than 2 years	29	14.8
Until 2 years	162	82.7
I don't know	2	1.0
Humans have colostrum
yes	163	83.2
no	2	1.0
I don't know	31	15.8
Colostrum Beneficent
yes	155	79.1
no	6	3.1
I don't know	35	17.9
Thoughts about night feeding
important	165	84.2
not important	5	2.6
tiring	20	10.2
I don't know	6	3.1
Definition of weaning
stop breast feeding	156	79.6
added other food type beside breast milk	37	18.9
I don't know	3	1.5
Suitable age of baby to start introducing supplementary feeding.
less than 4 months	20	10.2
4-6 months	83	42.3
after 6 months	91	46.4
I don't know	2	1.0

Table (2): Attitude towards breast-feeding and weaning:

variable	No.	%
Breastfeeding prevents the child from infection
agree	160	81.6
I don't agree	28	14.3
I don't know	8	4.1
Breastfeeding is an old fashion
agree	68	34.7
I don't agree	124	63.3
I don't know	4	2.0
Breastfeeding is more beneficial for infants
agree	191	97.4
I don't agree	4	2.0
I don't know	1	.5
Breastfeeding is embarrassing
agree	19	9.7
I don't agree	177	90.3
Breastfeeding strengthening mother-child relationship
agree	187	95.4
I don't agree	8	4.1
I don't know	1	.5
Breastfeeding prevents you from going to work
agree	64	32.7
I don't agree	131	66.8
I don't know	1	.5
Breastfeeding should be stopped during mother illness
agree	68	34.7
I don't agree	127	64.8
I don't know	1	.5
Breastfeeding should be avoided during child illness
agree	11	5.6
I don't agree	185	94.4
I don't know	0	0

Table (3) Mother's practice towards breastfeeding and weaning:

Variable	No	Percentage
Start breastfeeding
immediately after delivery	184	93.9
during the first 24 hours	10	5.1
after 24 hours	2	1.0
Child receive any meal before the first breastfeeding
yes	16	8.2
no	180	91.8
Child receive any of the colostrum
yes	170	86.7
no	5	2.6
I don’t know	21	10.7
Breast feed time
Scheduled	116	59.1
On demand	80	40.8
Breastfeeding style used commonly
from one breast	43	21.9
from both breasts	153	78.1
Duration of exclusive breastfeeding
<6 months	99	50.5
6 months	48	24.5
more than 6 months	10	5.1
Still on exclusive breastfeeding	39	19.9
Night feeds
yes	194	99.0
no	2	1.0
Start complimentary feeding
less than 4 months	20	10.2
4-6 months	80	40.8
after 6 months	57	29.1
Not yet	39	19.9
Continuation of breast feeding after introducing complimentary feeding
yes	154	78.6
no	3	1.5
Still on exclusive breastfeeding	39	19.9

Table (4): Socio-economic risk factors influencing Knowledge and attitude towards breastfeeding and weaning

Knowledge	Factors	Reference	P	OR	Lower	Upper
	=< 25 years	>25 years	0.026	2.169	1.095	4.295
	Primary school and below	Above primary school	0.000	4.795	2.495	9.212
	housewives	Employed women	0.043	5.063	1.051	24.397
	Independently employed	Employed women	0.034	7.907	1.169	53.743
Reference category good knowledge
Attitude	Home delivery	Institutional delivery	0.019	2.08	1.130	3.828
	Factors	Reference	P	OR	Lower	Upper
	Primary school and below	Above primary school	0.712	2.5	0.697	2.977
	=< 10 000	>10 000	0.324	1.441	0.697	2.977
Reference category positive attitude

No competing interests reported.

KAP study on Breastfeeding and Weaning in a Low Socio-economic Area in Sudan, 2020-2021

Status:

Version 1

Abstract

Figures

1.Introduction

2. Methods

2.5.1 Sample size:

2.6. Inclusion criteria:

2.8 Data collection tools and methods.

2.9 Data management and analysis:

2.10 Ethical consideration:

3.Results

4. Discussion

5. Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1

KAP study on Breastfeeding and Weaning in a Low Socio-economic Area in Sudan, 2020-2021

Status:

Version 1

Abstract

Figures

1.Introduction

2. Methods

2.5.1 Sample size:​

2.6. Inclusion criteria:

2.8 Data collection tools and methods.

2.9 Data management and analysis:

2.10 Ethical consideration:

3.Results

4. Discussion

5. Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1

2.5.1 Sample size: